I’m delighted to announce that I’ve been asked to join a number of leading Shockwave Therapy experts including Professor Christoph Schmitz, Professor Nicola Maffulli and Mr Jonathan Wride as a key speaker at the British Shockwave Association’s fourth conference.

The event, which is being held at the Park Crescent Conference Centre in Regent’s Park, London on Saturday 23rd March, follows a successful 2018 inaugural gathering, at which I also presented last year.

The conference, which costs £65 to attend, unites the shockwave community and aims to bridge the gap between device companies, clinicians and patients as well as share knowledge and ideas.

The BSWA is a relatively new association which adheres to national and international guidelines, whilst maintaining a pragmatic, non-exclusive approach in all specialities in which Shockwave Therapy has been proven to be effective.

The event offers both academic and evidence-based knowledge and I’ll be presenting a practical session which demonstrates how to correctly use shockwave equipment. I’ll also be facilitating discussions with seasoned practitioners on how they’re using Shockwave Therapy in their clinics as well as educating novices.

Everywhere you turn experts are outlining their predictions for 2019 so I thought I’d throw my hat into the ring and share what I believe to be the trends that will shape the world of Shockwave Therapy over the coming year based on my own personal experience.

INCREASED MEDICAL REFERRALS Doctors and physicians are waking up to the benefits that Shockwave Therapy can bring to their patients. In 2018, I saw a marked rise in the number of enquires I received from professors who were looking to refer patients with very specific issues, like joint replacements that had failed to respond to surgery, and stop complex medical revisions.

I was also inundated with requests from medical professionals seeking to build on their basic shockwave training. As some of you know, I’ve spent the past 14 years working closely with the leading shockwave bodies to develop a robust training protocol that has helped orthopaedic surgeons, sports physicians, physiotherapists, osteopaths and podiatrists solve problems in their clinics and develop successful shockwave services. I’m a qualified trainer in both focused and radial shockwave and also author of The Shockwave Solution – The Non-Surgical Answer to Becoming Pain Free’.

Last November I was invited to Switzerland to meet with members of the European Swiss Dolorclast advisory board, who’d gathered to set the standards and protocols for the delivery of shockwave treatment in Europe and around the world. I was in the presence of some very learned people, and asked to present my findings and experiences of using the treatment on athletes, which brings me nicely onto my next point…

SURGE IN POPULARITY AMONG ATHLETES Speaking of athletes, I think there’ll be a surge in the number of professional sportspeople trying the treatment as awareness grows. Some premier league football clubs in the UK currently use Shockwave on their players, as well as overseas clubs like AC Milan football club. Its scientific research centre, the Milan Lab, has researched and used Shockwave Therapy as a way of keeping their athletes in peak condition and resolving chronic injuries.This year I’ve successfully treated players with patella tendinopathy – severe inflammation of the main tendon that attaches to the lower part of the kneecap and shin bone, which has often been torn or degenerated in some instances. The players had all undergone surgery in the hope of rectifying the problem but were still in severe pain and had exhausted every other option. Most players had been suffering with these problems 2-3 years before seeing me; they couldn’t run, squat and had difficulty walking down the stairs. After undergoing Shockwave Therapy with me, they were able to start a successful rehabilitation programme for the first time because they were not in pain. Going forward, I think we’ll be treating more and more athletes as well as regular patients as the shockwave solution message spreads.

MORE SHOCKWAVE SUCCESS STORIES I believe more and more success stories will be heard as early adopters of the technique enlighten others about how it has helped, and still continues to help, years later. Last year I did an interview with Dr Peter Campbell, a very well respected medical practitioner who had this treatment for separate Achilles tendon and tennis elbow injuries. It worked. Six years on, he has had no further relapses, runs regularly and recommends the treatment (see the related video interview here).

To find out more about training in the evidence-based Swiss Dolorclast method you can contact me on 0208 662 1155

What can I say, it takes a lot for me to take a Friday off work and travel to Geneva, to visit like-minded professionals from around Europe consisting of 14 clinicians like myself, scientists, professors all treating patients at very high level sport (mostly national) and the general public at large - some working in very large teaching facilities, having resources available to develop high level RCT’s.

My trip started at Heathrow, bit of a trip but heard that Swiss Air was worth it, well apart from changing my seat so far so good. All wrapped up as in pic, heard cold out here in Geneva.

So I arrived at Geneva airport only to find my pals Professor Christoph Schmitz and Johnathan Wride was sharing the same transport to the wonderful Chateau de Bonmont. Didn't have too much time on arrival as a little late for the start of evening in fact missed the opening session from Paolo Zanetti, we all introduced ourselves and JC, (please see pic, seriously outsizing me and looking like a Gucci model) our chairman Per Andersen took us through what to expect on Saturday and we promptly headed for cocktails and dinner.

JC seriously outsizing me.

Early start on the Saturday, no gym so a 30 minute work in my very large, very beautiful room before a quick breakfast and on with case studies from all which was 5 minutes, offically and then the floor had to comment this went on until lunch.

In my presentation I referred to the previous night being slightly overdressed, the only man in TUX and now calling myself a dinosaur as I was the only clinicain using what is considered the ‘old’ frequencies!

My presentation was very factual, used my August blog for my examples on semi-professional footballers (males) with chronic knee pain. Needless to say outstanding results from RSWT using the DolorClast, and more over Professor Christoph said that I am correct with my choice of frequencies as in accordance with current RCT’s but some are finding other frequencies more benefical, which we spoke more about this over coffee.

Following lunch we had a great brainstorming 1.5 hours. I was on table innovation and in very good company with Johnny and Per having good discussions, recording appropriate treatment protocols, energy and grouping conditions together to assist EMS to get a collective to use around the world in terms of setting standards and solutions.

If I don’t mind saying, I think the UK (with Per) did very well, maybe Germany had the edge but were was close not that’s what it was about but it was competitive.

Christoph when through recent scientific literature and questions from the floor which really revealed differences from varying countries. Christoph is always very good value, and can prove everything he quotes with scientific evidence to support.

Next was my very good friend Aude, who was pushing everyone to use online tools and gave a good scenario for all and yours truly gave his penny worth regarding social as I did so much when I was there.

As you can see, this was my clip from my IG

JC finally went through the conclusion, what we all should be thinking about and getting together a group of Professionals to help develop with Swiss DolorClast Method.

We had a wonderful evening out, starting with wine tasting, which I abstained as getting over my chest infections and the most wonderful meal later. So all in all this is what has been instigated, the very first of its kind. A huge thanks goes to those at EMS for all the hard work, i.e JC, MC, Aude and our new arrival Yael.

It’s just the beginning, watch this space for development to the ‘Building the Future of the DolorClast Method’ and to that end very glad to be part thereof.

Sunday was really exhausted, rested went for a walk around the grounds and my delightful chaffuer look me back to Geneva airport and finally got back to Heathrow at 8pm. Till next year, looking forward to help develop (EDAB) and put EMS on the map even more than it currently is.

In summary, great weekend, met some very interesting clinicians who I’de like to get more involved with in terms of there research and studies. Super venue, felt really appreciated that made the effort to get to and simply be part of, ‘First European DolorClast Advisory Board (EDAB)’

Please my patient video, there’s an abundance of knee patients that have done so well with RSWT.

3. A very interesting small study that I shared and added more information from a colleague Professor Christoph Smidtz is definatinely worth a look at. Whilst most of the studies we see are realted to chronic recalcitrant cases the acutes do interest me- so say why wait? The simple answer is that we have guidelines here!

4. Then on 13th October my daughter and I got up at 4am to get Belfast to teach for the Swiss DolorClast Academy. We had a blast, great delegates with great sense of humour and wanting good studies and background to support ESWT. April my daughter was great help and took some great pics, one of us two,

The morning started with an academic look at Shockwave Therapy, discusing briefly how I got into ESWT in 2003/4 and moving on promptly to look at the Swiss DolorClast Method which is based around technology, clinical proof, and education.

I spoke principally about Radial therapy, but also briefly discussed the focused device that’s getting traction in the UK.

We reviewed EBM as it’s defined in the NHS, the approved conditions Shockwave can help with, and spoke about PEDro and the DolorClasts significance in terms of accepted RCT’s. An important note to this group being that of the accepted studies approximately 80% were performed using the Dolorclast, which speaks for itself.

Moving on to peer reviews, the the appropriate conditions, depth of treatments and the various MSK indications, the short and long term effects of Shockwave on the tissue before looking at what, in my opinion, really works to create success. Everything from patient selection to evidence of outcomes.

Finally, before lunch we looked at 3 conditions: Lateral epicondylitis; GTPS; and Plantarfasciopathy with the appropriate RCTs and the energies used.

Most find the level of energies used, too high to deliver to patients, so some time was spend discussing the essential role power plays to create angiogenesis. It’s important to educate the patient before hand, and remind them they have been in so much pain for a long period of time with the condition, refocusing that tolerance to the treatment, and with the right techniques from the practitioner, it’s usually possible to deliver the recquired energy and get a successful outcome.

“The response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer’s elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations.”

“Regarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies.”

Bring on ESWT!

A rather descriptive and visual ( even cautioned on social medial ) wound management and SW! Still medicine unaware to the benefits to patients, a must read if involved in wound care.

OMG wheres the sun gone, I must admit whilst difficult to work in clinically I loved the warmer weather.

So what been happening in the ESWT world, well in clinic I have had a number of young males from the world of football, some semi Pro's others good club level age 23-35 which chronic knee pain this month. All with Left knee, all post operative, having exhausted Physio and PRP injections. Delighted to say that all bar one are doing great, having 3 treatments pain free and now loading and 'exploding' as it were. The 'remainer' has a history of 3 years with severe P/T and 2 years since surgery, however theres a change in symptoms almost like a sub acute. Confident with a little more treatment he will do well, heres a link to some of the exercises given - apologises as the model somewhat senior!

Further, I had a part replaced on my red power hand piece which made me think about the hand pieces that I have used since 2003, the benefits to all particulary patients and also the revenue generated therefrom and huge thanks the the EMS Team, Aude, Marie-Christine and JC. Here's the link to the Video- grab a coffee first

Finally a good end to the month, my colleague and main EMS educator Mr Jonathan Wride did some great work with a UK athlete, Marilyn Okoro @mokoro4 so what this space and love the title 'Radial Shockwave Rocks'

Last week I received a replacement handpiece from EMS https://www.ems-dolorclast.com/en like most products they need to be regular servicing and indeed a replacement part periodically, shame are bodies are not so easily maintained!

To that end it gave me the idea about the history of the handpiece. This essentially started with the Radial devise and indeed the Power handpiece, which I have just had replaced and It should be mentioned and indeed recorded that these devises was used to get the current NICE guidelines https://www.evidence.nhs.uk/search?q=shockwave+therapy way back (2003 ) The Power hand piece is a devise where you need serious energy, for example Calcific Supraspinatus this can produce up to .55mj/mm2 in terms of energy output.

Some new comers to the world of shockwave may not be aware of this, and often other manufactures quote these references but have not got a scrap of evidence with there devises and essentailly 'piggy backing' on EMS's good work over the years.

This is also a direct result of us getting shockwave paid by the insurance companies which a good number of clinicains have benefited therefrom! Myself included I might add.

I am a user of the EMS product purely on the basis of #evidence I am an Ambassador for the product and get remuneration if I give training days for the https://www.swissdolorclastacademy.com

4.The only Radial Shock Wave device on the market with FDA approval for plantar fasciopathy

5. Appreciation to the hard work done by EMS and thank accordingly for the benefit of over 2000 patients from my clinic alone.

6. My understanding of Focused Shockwave is for deeper lesions such as early AVN, non union fractures and urology , but I did give an explanation to a patient that had who had a chronic de quervans, 2 years and where I need to use more energy and the patient may not have tolerated well the radial devise, I had a superb response and recorded here if you wish to see https://vimeo.com/278133049

My word what a period its been in the UK, sizzling comes to mind and forsure the world is in change, rather than gobal warming. Seemingly EMS gets everywhere, even at my annual party at my Cheyne Walk practice drinking my BCAA's to keep going -no alcohol as had to look after everyone!

Some very interesting things happened this month not all on LinkedIn, here's the hot list,

I had the most wonderful clinical result for a 2 year old dupuytren's with Dr Mary Onianwa using my Focused devise, it would have been difficult to delivery the energy required using my usual favoured evo blue. #shockwaveworks

Meta analysis always works well, check out my linkedin post on ESWT and osteonecrosis of the femoral head

Further, as this posted created so much interest I had a go a creating a video to same, script was done on the basis of the above and im pleased with the outcome save the AI's version of tendinopathy ( apologises in advance ).

It's great to see, as the month's progress, the audience for the blog grow. December when I first started this blog, seems like only yesterday, yet here we are, over half way through 2018, and it been great to hear the positive feedback. So welcome. I hope you continue to get a lot from this.

Today I was very pleased to interview another patient, this time with De Quervains tenosynovitis with a 2 year history pending surgery following the birth of child. See Dr Mary Onianwa testimonial to the remarkable help shockwave has afforded and my brief summary of upper limb conditions where shockwave can be effective.

I was asked to repost a Linkedin article about Shockwave that was well received:

There have been a few questions from the post, so watch this space for a video follow up.

There has been a lot of interesting talk recently about cavitation. I don't necessarily agree with the position some educators are giving the public and healthcare professionals, so I thought I would give my point of view here: